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Organization

PHAN H THANH M D P C

Active
Organization subpart
No

Provider details

NPI number
Authorized official
DR. THANH HUU PHAN M.D. (PRESIDENT)
(248) 681-1025
Entity
Organization

Contact information

Practice address
4000 HIGHLAND RD, SUITE 110, WATERFORD, MI 48328-2167
(248) 681-1025
(248) 681-1533
Mailing address
4000 HIGHLAND RD, SUITE 110, WATERFORD, MI 48328-2167
(248) 681-1025
(248) 681-1533

Taxonomy

Speciality
Code
Description
License number
State
208600000X
Surgery Physician
Primary
4301 035554
MI
2086S0129X
Vascular Surgery Physician
4301 035554
MI

Other

Other identifiers
Code
Description
Identifier
Issuer
State
01
0206316622
BCBSM/BCN
MI
01
87199A
HAP
MI
Enumeration date
03/04/2008
Last updated
04/04/2008
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